A multicomponent cardiac rehabilitation programme as a safe, feasible, and beneficial approach, including patients with left ventricular assist devices: a case report

Left ventricular assist devices (LVADs) are a well-established therapy for advanced heart failure (HF) used either as a bridge-to-transplant or destination therapy. While cardiac rehabilitation programmes (CRPs) are guideline-recommended in other HF stages, specific data on their role in LVAD recipients remains limited. We present a case of tailored CRP in a LVAD-supported patient highlighting the importance of understanding the device’s intrinsic limitations to ensure safe and effective exercise prescription.

A 56-year-old man with cardiovascular risk factors presented with anterior ST-elevation myocardial infarction developing severe left ventricular dysfunction, INTERMACS III, and recurrent ventricular arrhythmias, leading to HeartMate 3 (HM3) LVAD implantation as a bridge-to-transplant. Persistent smoking led to discontinuation of prehabilitation and removal from the transplant waitlist. A destination therapy strategy was considered and referred to the CRP. Baseline and final assessments included a CPET-ESE, clinical-functional evaluation, and PROMs. The rehabilitation physician, as part of the multidisciplinary team, adapted the exercise prescription to manage neuropathic pain due to a suspected spinal cord injury. Doppler-MAP and HM3 LVAD parameters were monitored before and after each session. The patient completed a tailored 12-week CRP with high adherence and no major adverse events. Improvements were observed in submaximal CPET parameters: VO₂ at VT1, OUES and VE/VCO₂ slope, right ventricle contractility, muscular efficiency, and QoL. Persistent smoking remained the main management challenge.

Tailored CRP with careful haemodynamic monitoring is safe, feasible, and effective in patients with HM3 LVAD. A multidisciplinary approach is essential to optimize functional outcomes and long-term prognosis.